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t ' CI3ECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> I' ADDRESS OR LEGAL: 3��S 5 v ss�.x [��� <br />, <br />� PID: <br /> DESCRIPTION OF WORK: G Ft�►�6� G R��� ���R s �-z_.,P <br />' ZO.�i 1G REVIEW BY: N(/� DATE APPROVED: <br /> I BUILDI�i tG REV�`V BY: _r,�� DATE APPROVED: � 3�-u z <br /> ---_____--___________ ------- ----------------------------------------y-------------- <br />�' FEES TO BE CHARGED: Misc. Fees Calculated B <br /> PERNIIT Yes � No <br /> PLAi�T REVIEW Yes No v SEWER CONNECTION <br /> STATE SURCHARGE Yes �/" No WATER CONNECTION <br /> INVESTIGATION FEE Yes No PARK FEE <br />' SAC Yes No SITEINSPECT'ION <br /> Number of SAC�Units OTHER (specify) <br /> ZO�TING CH�CK LIST Zoning District: ,7iv C l-r��r� <br /> Fire Department: Post Office: School District: <br /> Lot Area: Sq.ft. Acres Width Depth <br /> Survey Submitted: Yes No Date of Survey: <br />' Proposed Setbacks: <br /> Front (Lake): Right Sid . <br /> �I Rear (Street): Left Side: <br /> i <br /> i Adjacent Structures: etland: <br /> i <br /> ' I Building Height: Def. Hgt. eal:Hgt. <br /> Lot Coverage: <br /> Grading: Staff Approval Date: By: Council Approval Date: <br /> Septic: Staff Approval Date: By: <br /> Zoning File: # Resolution: # Resolution Date: <br /> i <br /> I Shoreland District: <br /> Avg. Setback: Bluff Setba k: L.ot Coverage: <br /> Existino Proposed <br /> I Hardcover: 0-75' <br /> ' 75-250' <br /> � <br /> � 250-500' <br /> � 500-1000' <br /> Hardcover Variance Required: Yes No Date of Council Approval: <br /> ' REMARKS (in house): ��t N 5 • C�v�`-P N /(�.v. � i <br /> SS C= <br /> I ; <br /> � 7 <br />